This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy.
The landscape of private practice has evolved rapidly since we have been coaching since 2010. We now have tech companies and directories that therapists can work for, online therapy software and companies, laws shifting for providing therapy across state lines, insurance companies that are changing how they do billing and so much more. Yet, even with these changes, the options for structuring your private practice remain to be - private pay, insurance-based, and hybrid.
Private pay practices have a cash fee and do not involve third-party payors in their practice at all. They may provide a superbill, but it is up to the client if they allow a third-party payor’s involvement. Insurance-based practices that exclusively take insurance are often working with billing companies or software to communicate with third-party payors. With many tech companies showing up in the therapy space, some of them are supporting these billing processes, negotiating fees, and managing the claw backs. Lastly, a hybrid practice is one that has a combination of both private pay and insurance provider involvement.
Is one of these options better than the other? Not necessarily. The key is choosing a structure that is profitable and sustainable for you. Profitable meaning that it provides a decent living wage for you and anyone you hire. Sustainable meaning that you can do business without it negatively impacting you, your clients, and your community. You want to look at doing this work in a way that allows for excellent outcomes, ethical practice and that doesn’t burn you out physically, emotionally, or spiritually.
There is no moral high ground for taking insurance. The variance from therapist to therapist shows us that not one single private practice is the same. We all have different circumstances and privileges at play when determining our private practice structure. What is most ethical is to choose that which is best for the client and for the therapist.
That said, many cannot afford to take insurance exclusively or in a hybrid model. If you have longed to be independent, not involving insurance companies in the therapeutic relationship, we want to explore how to make your private pay practice a possibility.
Pillar 1: Solid Systems for Private Pay
It’s time to ditch the hustle culture and really look at how many hours you can healthily give to your business, beyond your direct client work. Working nonstop is not what will get you a private pay practice. First start with honoring your energy and time and give to the practice what is sustainable for you. Having systems in place is what will help you find flow in working in your private pay practice. Some of the key systems every private pay practice needs are a consultation and onboarding process, financial plan, business plan, marketing systems, and self-care systems. All of these systems work together to make private pay more easeful in your practice.
Pillar 2: Confidence with Your Fee
Too often people feel they must lower their fee in order to attract cash pay clients, not considering the impact on clinical outcomes and the financial viability of their private practice. You want to charge a fee that allows you to do great clinical work without burnout while also covering the cost of living and retirement planning. This may also mean surrounding yourself with more supportive colleagues who understand that you need to create what works for you. Your needs are so different from your neighbors and thus your private pay fee will be different from others as well. Again, this is about what is sustainable for YOU.
Pillar 3: Standing Out
Private pay private practices stand out from other practices when they are clear on who they are as a clinician and how they best help and with whom they get the best outcomes. Setting a standard of excellence in clinical care is key. You want to be able to be crystal clear on your strengths and with whom you do great work. Gone are the days of taking whoever calls because you accept their insurance. Look at how much more you will feel confident to charge your fee, to invest in clinical training, and to market your practice when you are clear about your unique approach to therapy and who you love working with.
With these three pillars, you can create the right structure of private practice for you. Private pay is possible, but it does take some systems, planning, clarity, and confidence to get you there. If you want to learn more about these pillars and what you need for a private pay practice that is sustainable and profitable, check out this free 90 minute training.